title: Serial monogamy and biologic concurrency: measurement of the gaps between sexual partners to inform targeted strategies.
abstract: Having multiple sexual partners concurrently increases the risk of transmission of a sexually transmitted infection. Even if partnerships do not overlap, transmission potential exists when the gap between partnerships is shorter than the remaining infectious period. In the present article, we quantify the gap between partners to assess transmission potential using data collected by a cross-sectional survey of 2,203 genitourinary medicine clinic patients in England in 2009. Questionnaires asked about patients' 3 most recent partnerships. Gaps were calculated as time (days) between the last sexual encounter with a former partner and the first sexual encounter with the next partner. Among 1,875 patients who reported 1 or more partners in the previous 3 months, 47.6% of men and 27.7% of women reported 2 or more partners. Forty-two percent of the gaps were negative (i.e., partnerships that were concurrent); the median gaps were -7 and -17 days for men and women, respectively (i.e., overlaps were 7 and 17 days for men and women, respectively). Although half of the gaps were positive (serially monogamous partnerships), many were of short duration; the median gaps were 14 and 24 days for men and women, respectively. In over half of the gaps, condoms were used inconsistently with one or both partners, and in one-quarter, condoms were never used with either partner. There is thus a high potential for sexually transmitted infections, as even if partnerships are not behaviorally concurrent, they may be biologically concurrent. These data have important implications for designing and targeting effective health promotion messages.
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK. c.mercer@ucl.ac.uk
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
authors.forename: Catherine R H
authors.initials: CR
authors.lastname: Aicken
authors.forename: Clare
authors.initials: C
authors.lastname: Tanton
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Estcourt
authors.forename: M Gary
authors.initials: MG
authors.lastname: Brook
authors.forename: Frances
authors.initials: F
authors.lastname: Keane
authors.forename: Jackie A
authors.initials: JA
authors.lastname: Cassell
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000517:prevention & control / Q000635:transmission*; D011795:Surveys and Questionnaires; D013997:Time Factors; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: concurrency; partnerships; serial monogamy; sexual partner; sexually transmitted infection; survey; transmission